AUSTIN—Today the Texas Senate Committee on Business & Commerce considered SB 481, introduced by Sen. Kelly Hancock, R-North Richland Hills, which would address the practice of balance billing, a growing occurrence for Texas consumers who seek care at in-network facilities but are in fact treated by out-of-network providers at those facilities and later receive separate bills for charges not covered by their insurance. The Texas Association of Health Plans supports SB 481 as a common-sense approach to empowering consumers and boosting transparency in the balance billing process.

“As it stands, many out-of-network physician groups have established exclusive agreements—essentially monopolies—with in-network hospitals that result in patients receiving out-of-network emergency care without their knowledge and experiencing the sticker shock of exorbitant charges after the fact. TAHP supports expanding the use of mediation–already being successfully and efficiently utilized in Texas—as a way of protecting consumers against the unfair practice of balance billing. A more expansive use of mediation will bring a higher degree of fairness to the situation and, ultimately, better protect Texans from surprise debt,” said Jamie Dudensing, CEO of Texas Association of Health Plans, who testified before the Business & Commerce committee today in favor of SB 481.

Background

Balance billing is a practice increasingly occurring across Texas that is surprising individuals and their families with unexpected medical charges, often when they are seeking emergency medical care. Balance billing occurs when patients seek care at a medical facility identified by their PPO plan as “in-network,” but are in fact treated by medical personnel who are “out of network.” The patient will then receive separate bills, one for the in-network facility, and at least one for the out-of-network provider. The latter can include fees that exceed the amount covered by the patient’s insurance– sometimes hundreds of times the accepted rate. If physicians aren’t bound by an in-network contract, they can set rates for their services beyond the going rate and charge patients every last cent that is not covered by insurance.

Economists and advocates estimate that consumers routinely pay almost $1 billion a year due to balance billing.

A survey conducted by America’s Health Insurance Plans revealed health plans and consumers routinely receive bills from doctors that are 10 to 20, or sometimes nearly 100 times higher than Medicare.

A recent study by the Center for Public Policy Priorities (CPPP) found that 23 Texas hospitals that have contracts with the state’s largest PPO plans do not have any emergency room doctors who contract with those plans.

CPPP found that the percent of in-network hospitals in Texas with no in-network ER doctors ranged from 21%-56%.

SB 481

Expands the options for consumers to go to mediation when they are balance billed by simply eliminating the current $1000 threshold for claims eligible for mediation.

Adds additional facility based physicians to the list of providers that consumers may request mediation from.

The Texas Association of Health Plans

The Texas Association of Health Plans (TAHP) is the statewide trade association representing private health insurers, health maintenance organizations, and other related health care entities operating in Texas. Our members provide health and supplemental benefits to Texans through employer-sponsored coverage, the individual insurance market, and public programs such as Medicare and Medicaid. TAHP advocates for public and private health care solutions that improve the affordability, access and accountability of health care for many Texans. As the voice for health plans in Texas, TAHP strives to increase public awareness about our members’ services, health care delivery benefits and contributions to communities across Texas.